1215148341 NPI number — DR. STEPHANIE M MEYER MD

Table of content: DR. STEPHANIE M MEYER MD (NPI 1215148341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215148341 NPI number — DR. STEPHANIE M MEYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
STEPHANIE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215148341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 NOONAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63069-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-271-9100
Provider Business Mailing Address Fax Number:
636-257-6016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 NOONAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACIFIC
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63069-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-271-9100
Provider Business Practice Location Address Fax Number:
636-257-6016
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2009001451 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215148341 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00779628 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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